Tinnitis Questions

1.  Are there different types of tinnitis?   Yes.  Most forms of tinnitis are a continuous noise in the ear that does not pulse like a heartbeat.  It is described as a continuous ringing, buzzing, hissing, or summer insect sound.   It is mostly in both ears and noticed in a quiet room and most of the time goes unnoticed when the patient is busy or when there is background noise.    The second major type of tinnitis is pulsatile tinnitis.   This is usually due to flow of blood through vessels.   Most often it is due to turbulent blood flow through normal or aging vessels, but may be due to blood flow through abnormal vessel connections or a vascular tumor.  

2.  Is tinnitis normal?   Aging and genetic deterioration of the nerve endings in the inner ear is the most common cause of bilateral non-pulsatile tinnitis.  There is no way to avoid this since it is genetically programmed into the patient.  Fortunately, it is usually a symptom that can be masked by background noise and the patient should make attempts at ignoring the noise.  If the hearing is symmetrical there is no need for further work-up.

3.   What are other causes of tinnitis?   Trauma to the ear can cause tinnitis.  This may be direct trauma such as a head injury or skull fracture in which the  delicate inner ear membranes are damaged.    Viruses are a fairly common cause of inner ear injury and can cause one sided hearing loss and tinnitis.   Noise trauma is probably the second most common cause of tinnitis.   This can occur regardless of the type of noise exposure (music, guns, machinery)  and is related to the loudness and duration of the exposure.   This is progressive and   permanent and is avoidable by limiting exposure and wearing hearing protection.     Rarely tinnitis is caused by a benign tumor on the hearing nerve.   This is usually associated with hearing loss and tinnitis that occurs on one side only.  

4.   When is tinnitis worrisome?   Unilateral tinnitis may indicate a hearing nerve tumor and requires hearing testing and often scanning to rule this out.    Pulsatile tinnitis may indicate a vascular tumor and requires a thorough head and neck examination and often scanning to rule out a vascular tumor.   Bilateral continuous non-pulsatile tinnitis associated with aging is common and not worrisome.  It rarely needs more than an audiogram.

5.  What are the treatments?   After the evaluation has ruled important or rarely serious causes of tinnitis there is little to do for this problem.  Most patients learn to live with the noise and learn to ignore it.   Background noise and avoiding quiet paces helps to mask the noise and can make it more tolerable.  Tinnitis maskers, or devices that place a noise in the ear to suppress the tinnitis can be helpful in persistant cases, but they sometimes interfere with hearing.   Hearing aids can help to provide more sound and mask the tinnitis if the patient has a hearing loss.   Accupuncture and bio-feedbak have a very mixed result and are rarely used.  Sedatives or nerve suppressing drugs are rarely prescribed due to their sedating effects and poor patient tolerance.   In general,   masking with background noise is the safest and most commonly used treatment.